Effects of heart rate on left ventricular filling dynamics: assessment from simultaneous recordings of pulsed Doppler transmitral flow velocity pattern and haemodynamic variables

Abstract

Objective: The effects of heart rate on transmitral flow velocity pattern are still controversial. The aim of this study was to examine the relations between the changes in Doppler echocardiographic variables and those in haemodynamic variables in association with altering heart rate. Methods: Pulsed Doppler transmitral flow velocity pattern and left atrial and left ventricular pressures were simultaneously recorded at various heart rates (from 80 to 120 beats·min⁻¹) in 14 dogs. Results: As heart rate increased, peak late diastolic filling velocity increased, the time-velocity integral of the early diastolic filling wave decreased, and the decleration time of early diastolic flow shortened without significant changes in mean values of peak early diastolic filling velocity and acceleration time of early diastolic flow. Peak early diastolic filling velocity increased with heart rate, however, in five dogs and decreased in the other nine dogs. The shortening of the time constant of left ventricular isovolumic relaxation was greater in the five dogs in which peak early diastolic filling velocity increased with heart rate than in the other nine dogs. Results of multiple stepwise linear regression analysis showed that the changes in peak early diastolic filling velocity correlated with the changes in the crossover pressure and peak+dP/dt in addition to the time constant, and that diastolic filling period was not selected as an affecting factor. Changes in the other Doppler echocardiographic variables did not correlate solely with changes in heart rate, or diastolic filling period, but correlated in a complex fashion with the combined changes in haemodynamic variables associated with altering heart rate. Conclusions: Although transmitral flow velocity pattern changes with altering heart rate, this change is not considered to be a direct effect of alteration in heart rate, but an indirect one through the associated haemodynamic changes including left atrial pressure and left ventricular relaxation and contractility. Cardiovascular Research 1993;27:935-941